Individual
DR. JACQUELYN H PATTERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
2320 S TIBBS AVE, INDIANAPOLIS, IN 46241-4801
(317) 241-2019
(317) 487-2182
Mailing address
103 ROHN RD, MOORESVILLE, IN 46158-8073
(317) 831-8480
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001954A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18001954B
CONTROLLED SUBSTANCE CERTIFICATE
IN
05
—
200970100
—
IN
Enumeration date
10/16/2006
Last updated
05/31/2012
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